Active NPI
Matthew David Shade, MED., ATC
- Athletic Trainer
- Yardley, PA
National Provider Identifier
1346383536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT004081
- Practice address
- 365 N Fieldstone CT
Yardley, PA 19067-5709 - Phone
- (215) 595-7132
- NPI assigned
- Feb 15, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | RT004081 | PA | Primary |
Addresses
Primary practice location
365 N Fieldstone CT
Yardley, PA 19067-5709
Mailing address
365 N Fieldstone CT
Yardley, PA 19067-5709
Phone (215) 595-7132
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RT004081 | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1346383536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "365 N FIELDSTONE CT",
"city": "YARDLEY",
"state": "PA",
"postal_code": "190675709",
"telephone_number": "215-595-7132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "365 N FIELDSTONE CT",
"city": "YARDLEY",
"state": "PA",
"postal_code": "190675709",
"telephone_number": "215-595-7132"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADE",
"first_name": "MATTHEW",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "MED., ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT004081",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yardley, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.